Contributor: Gresham T. Richter, MD (Arkansas Children’s Hospital)
Pressure equalization tube placement is one of the most common procedures in the pediatric population. This video demonstrates the surgeon’s view of the right ear through the operative microscope.
Indications: recurrent otitis media with effusion, chronic otitis media with effusion (>3 months duration), speech/language delay secondary to otitis. Instruments: operative microscope, ear speculum, ear curette, myringotomy knife, suction tube, pressure equalization tube
1. Speculum inserted into external auditory canal
2. Cerumen removed with the curette (not shown in video)
3. Myringotomy performed on anterior-inferior quadrant of tympanic membrane
4. Fluid aspirated with suction tube
5. Pressure equalization tube (PET) inserted and secured
6. Antibiotic otic drops applied
7. Cotton dressing applied
Recommended Resource: Lambert E, Roy S. Otitis media and ear tubes. Pediatric Clinics of North America. 2013;60(4):809-26. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23905821
The authors have no conflicts of interest or financial disclosures.
This is an eye from a young man who was working with metal and a piece of metal shot into his eye, through his cornea and lens and landed on the retina causing a crater. In this surgery we remove the metal and repair the retina.
Phacoemulsification of a cataract
Samia Nawaz, John Chancellor, and Ahmed Sallam
A cataract can be simply defined as clouding of the lens of the eye. As the proteins that make up the lens of the eye harden and aggregate, a cataract forms. Cataracts are attributed to cause half of vision loss in the population and are most commonly related to age, although trauma, radiation exposure, and genetics have also been implicated. Cataracts can cause visual disturbance such as faded color perception, blurry vision, reduced night vision, and the perception of seeing halos around lights. Due to these hindrances, surgery is a common approach to alleviate the problems they cause. Phacoemulsification is a technique that uses ultrasonic waves to emulsify the dysfunctional lens, and we may then replace it with a synthetic one, clarifying vision. A 55 year old patient presented with reduced visual acuity due to a cataract in their left eye. A phacoemulsification of the cataract with implantation of an intraocular lens was performed here.
First, the patient’s eye was anesthetized using topical anesthetic. The patient was prepped and draped using sterile technique. A knife was then inserted into the cornea 90 degrees to the presumed incision site. This is known as the primary port incision. After this, incisions are placed 45 degrees to the presumed incision site, known as the secondary port incision. Viscoelastic was then inserted into the anterior chamber. Continuous curvilinear capsulorrhexis was performed using capsulorrhexis forceps to open the anterior capsule of the eye. We began with a central linear cut, then pulled the needle in the direction of the desired tear, allowing the capsule to fold over. We had created a flap we used to gain entry to the lens. We injected salt solution under the anterior capsule in a step called hydrodissection, allowing the fluid to decompress the anterior capsule by compressing the central part of the lens. Nuclear rotation, a step which mobilizes the nucleus and minimizes the possibility of damage to the zonular fibers or posterior capsule, was then performed. Phacoemulsification was begun after this, where ultrasonic waves broke up the nucleus of the lens into smaller pieces, thereby fragmenting the cataract and emulsifying it into a mixture to be irrigated and aspirated. We then inserted an irrigation/aspiration instrument to remove residual pieces of lens cortex. The last step was insertion of the pre-folded synthetic lens. We reformed the anterior chamber with viscoelastic, and then loaded the lens in with a cartridge. It will unfold and settle into the eye with our adjustments. We then irrigated the wound to decrease leakage by swelling up the wound edges.
The patient was discharged the same day and followed up in clinic 1 week later. The incisions were healing well with no indications of infection or wound dehiscence.
Phacoemulsification of a cataract is a successful and widely used way of alleviating reduced visual acuity as a result of cataract formation in the eye.